USMLE Question of the Week

Difficulty Feeding and Jaundice in a Two-Week Old Baby

In Episode 63 of Med School Question of the Week for USMLE, Faustine Ramirez, MedSchoolCoach expert tutor, answers this medical school question: A 2-week-old infant is brought to the pediatrician’s office for an initial examination. She was born at home at 38 weeks’ gestation to a 26-year-old primigravid woman. The parents have no medical problems, and the pregnancy was uncomplicated. They are concerned that she has difficulty latching when she breastfeeds and takes a long time to feed. She does not wake up regularly for feeds every 2-3 hours. Vital signs are within normal limits. Weight is in the 74th percentile, length is in the 48th percentile, and head circumference is in the 92nd percentile. On examination, the infant has large, soft fontanels, a large protruding tongue and her face appears puffy. She has a hoarse cry when she is unswaddled. Her skin is jaundiced and slightly dry. Cardiac examination is unremarkable. The abdomen is soft, non distended, without hepatosplenomegaly. She has a small reducible umbilical hernia. Her suck is slightly uncoordinated and she has mild hypotonia. Which of the following is most likely to have predicted these findings?
  • Prenatal ultrasound
  • Maternal glucose tolerance testing
  • Paternal karyotype analysis
  • Routine newborn screening
  • Amniocentesis
  • Prenatal inhibin levels
  • Prenatal alpha-fetoprotein levels
  • Maternal RPR testing
Click to Reveal the Correct Answer

Routine newborn screening

Faustine Ramirez

Faustine graduated from the University of Washington in Seattle with a B.A. in Medical Anthropology and Global Health. She attends medical school at University of California, San Francisco where she designed and taught a course on clinical reasoning skills, developed curriculum materials for the pre-clinical pediatrics course, and led case-based sessions in pediatrics and infectious disease. She received a 253 on Step 1 and a 266 on Step 2 CK, and she scored in the 90th percentiles on all of her shelf exams.

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